KEYNOTE - D36: personalized immunotherapy with a neoepitope vaccine, EVX-01 and pembrolizumab in advanced melanoma

Despite improvements made with checkpoint inhibitor (CPI) therapy, a need for new approaches to improve outcomes for patients with unresectable or metastatic melanoma remains. EVX-01, a personalized neoepitope vaccine, combined with pembrolizumab treatment, holds the potential to fulfill this need. Here we present the rationale and novel design behind the KEYNOTE - D36 trial: an open label, single arm, phase II trial aiming to establish the clinical proof of concept and evaluate the safety of EVX-01 in combination with pembrolizumab in CPI naive patients with unresectable or metastatic melanoma. The primary objective is to evaluate if EVX-01 improves best overall response after initial stable disease or partial response to pembrolizumab treatment, in patients with advanced melanoma. The novel end points ensure a decisive readout which may prove helpful before making major investments in phase III trials with limited phase I data. Clinical Trial Registration: NCT05309421 (ClinicalTrials.gov).

Modernizing smallpox vaccine stockpiles

Modernizing smallpox vaccine stockpiles Authors’ response

Surveillance of ambulance dispatch data as a tool for early warning

Early detection of disease outbreaks is essential for authorities to initiate and conduct an appropriate response. A need for an outbreak detection that monitored data predating laboratory confirmations was identified, which prompted the establishment of a novel symptom surveillance system. The surveillance system monitors approximately 80% of the Danish population by applying an outbreak detection algorithm to ambulance dispatch data. The system also monitors both regional and national activity and has a built-in, switch-on capacity for implementing symptom surveillance reporting in case of an alert. In an evaluation with outbreak scenarios it was found that decreasing the outbreak detection sensitivity from a prediction limit of 95% to one of 99% moderately reduced the time to detection, but considerably diminished the number of false alerts. The system was able to detect an increased activity of influenza-like illness in December 2003 in a timely fashion. The system has now been implemented in the national disease surveillance programme.

Surveillance of ambulance dispatch data as a tool for early warning

Early detection of disease outbreaks is essential for authorities to initiate and conduct an appropriate response. A need for an outbreak detection that monitored data predating laboratory confirmations was identified, which prompted the establishment of a novel symptom surveillance system. The surveillance system monitors approximately 80% of the Danish population by applying an outbreak detection algorithm to ambulance dispatch data. The system also monitors both regional and national activity and has a built-in, switch-on capacity for implementing symptom surveillance reporting in case of an alert. In an evaluation with outbreak scenarios it was found that decreasing the outbreak detection sensitivity from a prediction limit of 95% to one of 99% moderately reduced the time to detection, but considerably diminished the number of false alerts. The system was able to detect an increased activity of influenza-like illness in December 2003 in a timely fashion. The system has now been implemented in the national disease surveillance programme.

Parvovirus B19 infection infrequently involved in children and adults with myelodysplastic syndrome

Parvovirus B19 infection has occasionally been reported to mimic myelodysplastic syndrome (MDS) or to cause worsening of anemia in MDS. We examined the presence of parvovirus DNA in a series of children (n=19) and adults (n=39) with a diagnosis of MDS. The series of adults included only refractory anemia (RA) and RA with ring sideroblasts (RARS). Investigation for parvovirus B19 DNA in bone marrow cells was performed employing the nested form of the polymerase chain reaction (PCR). Only a 51-year-old male with RA tested positive for parvovirus DNA. Serial examinations demonstrated the disappearance of parvovirus DNA from the bone marrow. We conclude that parvovirus infection may only rarely mimic MDS or be a superimposed infection in childhood MDS or in RA and RARS in adults.